THE PRESENCE of granulomata in the liver in association with clinical jaundice but with no other evidence of systemic disease is extremely unusual. Diagnosis in these cases, furthermore, may be very difficult and, not infrequently, remains obscure. The case history which follows offered just such a diagnostic challenge and is being reported because of the atypical clinical picture, laboratory findings, and response to therapy.

Report of Case

First Hospital Admission.—A 32-year-old married Negro housewife was first admitted to the Hospital of the University of Pennsylvania Aug 20, 1962, with the chief complaints of weakness and tiredness of three months' duration. She was in good health until May, 1962, when she noted the onset of lethargy, weakness, fatigue, anorexia, and weight loss, for which her local physician gave her a "tonic" and three injections (thought to be vitamins). At that time also, her mother was seriously ill and the patient